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Why create a why?

“So what are you hoping to get out of therapy?”  Invariably, that question triggers a look of puzzlement on many clients faces.  “Umm.. I guess to stop- drinking, fighting, worrying, missing school, crying, cutting, (fill in the blank)?” Or perhaps panic “I have no idea! How am I supposed to know! Aren’t you supposed to tell me?  Stop pressuring me! Oh, the pressure!”

While we still have a way to go, it is obvious when looking into the rear-view mirror that quite a distance has been covered on the road to de-stigmatizing mental illness.  Be it how we view those who struggle with mental illness or the easing up on the resistance to seek help, as a society and a community we have made encouraging progress. We made it into the room.  Time to roll our sleeves up.

Hold up.

Winston Churchill once said “If you’re going through hell, keep going.”  On one hand, I agree with the sentiment of perseverance and never giving up.  On the other hand, I believe there is a perquisite to following through on the ‘keep going’ attitude; a why.  Even in midst of the most gruesome, tragic, and unfathomable tragedies throughout history, individuals have been able to tap into that strain of survival buried somewhere in their DNA.  I recommend picking up ‘Man Search for Meaning’ by Viktor Frankel which takes a fascinating observers perspective on why certain individuals somehow connect to that quality while others wilt and fade away.  Well worth the time. Back to Sir Winston. The only way someone will be willing to continue going through hell is if they have a reason to. Whether it be like Frankel posits, to find meaning within the journey, or like the chicken, to get to the other side, there has to be something.

What I have noticed from the other side of the couch, is that most people who make it into a therapist’s office have a form of one of the following 3 responses to this question; a) No idea why I’m here. There are at least 6 other places I can think of where I would rather be right now, one of them being the dentist. Someone else (parent, spouse, court is forcing me to be here. B) I know what brought me in.  This problem has disrupted my life enough to force me to take time out of my day and spend money to be here right now.  C) I am fully aware of what has brought me into this room, why I am here, and what I would like to get out of this process.  I have learned that the ones most likely to maximize the benefits of treatment fall in the latter category.

So what do I mean by a why and what does it look like?

A why is the true reason for taking the brave step of entering therapy and only that person can identify it.  There is no correct or incorrect answer. It can be anything from being a more present parent, to feeling good enough to pursue career advancement, or connecting with a spouse in more fulfilling manner.  It may take some hard, honest reflection to find it, but it’s there. I would argue that this is the most significant predictor of success in treatment. If there is no why, then time, money, and energy wears one down quite efficiently.  

Let’s play this out.

Dave comes in and shares his presenting concern is intrusive thoughts about the safety of his children.  Unable to sit with these thoughts, he submits himself to them by calling their school several times daily “just to check in on them”.  He also doesn’t let his children play at friends’ houses, go into the sandbox at the park, or ride the Ferris wheel. “You can never be too careful”, he posits.  “So what do you want to get out therapy?” I ask.

Pause.  The response to this is telling.

“What do you mean, what do I want?  I don’t want these thoughts!”


(Irritation beginning to fester) “Because its driving me nuts, that’s why!  I don’t get why you’re asking me this.”

“Let me clarify Dave.  What I mean to ask is, beyond the immediate relief of these thoughts controlling your life.  What will you gain when they’re gone, or in check?”

“Ohhhh.  That’s easy. Freedom.”

“Great.  Go on. What does freedom mean to you? What else will you gain?”

“I’ll be able to enjoy my family, be there for my kids instead of annoying them with so many rules, and just appreciate each day.”

Freedom.  Family. Present parenting.  Daily life. All fantastic whys.


“I can’t tell you it’s going to be easy- I’m telling you it’s going to be worth it.”

  • Art Williams

If you have a why that is.  

Find it. Name it. Pursue it.


A few tips on finding your why.  Ask yourself the following questions;

  1. What have a lost or missed out on because of this so called ‘problem’?
  2. Why would my loved ones want me here?
  3. How have they lost out because of this behavior?
  4. How would my daily life look compared to yesterday if this change magically occurred overnight?
  5. What new (and old) opportunities/feelings/thoughts/dreams/ relationships/goals would now be on the radar?

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Shmuel Fischler

Shmuel Fischler is a Maryland based clinical social worker who is deeply involved in communal work as well as clinical practice. He is owner and director of CBT Baltimore, a specialized group practice founded on Cognitive Behavioral Therapy. They work with individuals struggling with Anxiety spectrum disorders such as Obsessive Compulsive Disorder, Panic, Trichotillomania, and Hoarding. Shmuel is also Director of Outreach for CHANA, a local agency working with survivors of trauma and abuse. He initiated the Magen Yeladim Safety Kid program in Baltimore and was fortunate to steward the Boy to Mentsch program, an initiative to build healthy relationship skills among the young men of our community.